Ischemic colitis following colonoscopy in an elderly patient on cardiovascular medication.

cation following colonoscopy, with only four reports so far in the literature in Eng− lish [1 ± 4]. An 81−year−old woman underwent a total colonoscopy for assessment, prompted by occasional abdominal pain and a positive fecal occult blood test. For cleaning of the large bowel, she ingested a solution of magnesium citrate. Four colonic polyps were endoscopically resected, including one in the sigmoid colon that was 1.5 cm in size (l" Fig. 1). She had been receiving nicardipine hy− drochloride, propranolol hydrochloride, and digoxin for hypertension and infre− quent palpitations over 40 years. She had no history of connective tissue disease. The patient complained of abdominal pain in the left lower quadrant, 2 hours later, and this was followed by intermit− tent fresh bleeding from the anus over− night. On the next day, she had an elevat− ed white blood cell (WBC) count (10 100/ mL), reduced hemoglobin level (12.4 g/dL), and raised C−reactive protein (CRP) level (3.82 mg/dL), compared with the values before polypectomy (6200/mL, 13.9 g/dL, and 0.09 mg/dl, respectively). An emer− gency colonoscopy was then performed, which disclosed a segmental area of long− itudinal petechial hemorrhages with ede− matous mucosa between the middle sig− moid colon and the sigmoid±descending colon junction (l" Fig. 2), that was com− patible with findings of ischemic colitis. The possibility of bleeding from any of the polypectomy sites was excluded by the complete colonoscopy examination (l" Fig. 2 c). The patient made an un− eventful recovery with conservative treatment, and her WBC count and CRP returned to normal levels in one week. She was discharged 8 days after the first colonoscopy. According to a recent review, colonoscopy itself can be a causative procedure that predisposes to colonic ischemia [5]. In ad− dition, antihypertensive agents and di− goxin may decrease intestinal blood flow and have been postulated as risk factors [5]. We speculate that intake of these drugs also contributed to the disease manifestation in this patient.